Serum Sodium Levels Research Articles

The prevalence and outcomes of hyponatremia in children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C).

To assess the prevalence of hyponatremia among pediatric patients with coronavirus disease 2019 (COVID-19) and Multisystem Inflammatory Syndrome in Children (MIS-C) and determine if pediatric hyponatremia was associated with an increased length of stay, higher rates of mechanical ventilation, and/or elevated inflammatory markers on admission as compared to eunatremic patients. Electronic health records were retrospectively analyzed for 168 children less than 18 years old with COVID-19 or MIS-C who were admitted to pediatric units within the Northwell Health system. The primary exposure was hyponatremic status (serum sodium <135 mEq/L) and the primary outcomes were length of stay, mechanical ventilation usage and increased inflammatory markers. Of the 168 children in the study cohort, 95 (56%) were admitted for COVID-19 and 73 (43.5%) for MIS-C. Overall, 60 (35.7%) patients presented with hyponatremia on admission. Patients with hyponatremia had higher rates of intensive care unit admission when compared to eunatremic patients (32/60 [53.3%] vs. 39/108 [36.1%], p = 0.030). In regression models, hyponatremia was not significantly associated with increased length of stay or mechanical ventilation rates. After adjustment for relevant confounders, hyponatremia remained associated with an increased square root CRP (β = 1.79: 95% CI: 0.22-3.36) and lower albumin levels (β = -0.22: 95% CI: -0.42--0.01). Hyponatremia is common in pediatric COVID-19 and MIS-C. Hyponatremia was associated with a lower albumin and higher square root CRP levels. This may suggest an association of inflammation with lower serum sodium levels.

The Association between Serum Sodium Level, Incidence and Severity of Complications in Liver Cirrhosis

The Association between Serum Sodium Level, Incidence and Severity of Complications in Liver Cirrhosis

The therapeutic effect of oral desmopressin lyophilisate formulation in children with central diabetes insipidus.

We aimed to assess the efficacy of oral use of oral desamino-D-arginine-8-vasopressin lyophilisate (OLD) in children with central diabetes insipidus (CDI). Clinical, laboratory, and imaging characteristics of twenty-five children with CDI treated with OLD were evaluated. Fourteen boys and eleven girls with a mean age of 52.37 months were evaluated. These children (mean weight and height at admission, 26.81±14.8 kg vs. 92.52±30 cm) presented with failure to thrive, irritability, prolonged fever, polyuria and hypernatremia (mean sodium level, 143.12±8.6 mEq/L). At the time of hypernatremia, mean serum and urine osmolality were 298.2±18 mOsm/kg and 160.20±8.7 mOsm/kg, respectively. ADH levels were undetectable (<0.5 pmol/L) at admission in all cases. Oral administration of desmopressin lyophilisate (120 µg/tablet) was initiated at a dose of 5 μg/kg/day in two divided doses together with controlled water intake to avoid hyponatremia. Serum sodium levels normalised in a mean durationof 15.2±16.4 h with a mean decline rate of 0.12±0.04 mEq/L/h. Nine children needed rehospitalization because of hypernatremia due to non-compliance. Four episode of hyponatremia was observed. Weight gain and growth were normal during the mean follow-up duration of 37.79±48.2 months. Administration of OLD was practical and safe in the treatment of CDI in children with CNS malformations in this small retrospective series.

Does hyponatremia pose a risk factor for hip fractures in the elderly? Can a primary physician prevent it?

Fracture around the hip is amongst the most common and serious fractures in the elderly, which leads to significant morbidity and mortality. In literature, many authors noted that even mild hyponatremia adversely affects bone, leading to an increased incidence of fractures. We aim to determine whether chronic hyponatremia (>90-day duration) increases the risk of hip fracture in the elderly and whether primary care physicians can help to prevent it. During the period from January 2020 to March 2022, we identified 145 patients aged between 65 and 90 years who were admitted to the hospital with hip fractures following a fall and compared them with 140 healthy controls. We recorded sodium (Na) serum levels in all included patients at the time of arrival and consequently for 3 days and compared them with those of controls. Logistic regression was used to calculate odds ratios (ORs). We measured serum Na levels for 3 days and took the average to ascertain hyponatremia. In the study, the odds of hyponatremia were 70.3% with a confidence interval of 95% versus 3.6% in controls (P = 0.05). Age and hyponatremia were strongly associated with hip fractures following a fall. With a 5-year increase in age, the univariate OR for hip fracture increased by 5.67 (P < 0.0001). After adjusting for age, cases were nearly six times more likely to be hyponatremic than controls (OR = 4.90, P = 0.04). In our study, we noted that even mild chronic hyponatremia in old age increased the chance of falls. Addressing hyponatremia in the elderly may reduce the risk of falls and minimize hip fractures.

Survival and Functional Outcome in Children with Traumatic Brain Injury Requiring Ventilatory Support: A Prospective Observational Pilot Study

Abstract Background In children, incidence of traumatic brain injury is high and identifying predictors of poor outcome can help clinicians make decisions in the acute phase of treatment. We thus planned to analyze the survival and functional outcome of children following traumatic brain injury. Our study included children (1–10 years of age) requiring ventilation and admitted to trauma intensive care unit of our hospital following traumatic brain injury. Our primary aim was to determine patient outcome using the modified Glasgow Outcome Scale at 3 months following hospital discharge. Our secondary objectives included patient outcome at 1 month following discharge and factors which may affect outcome. Methods Data (epidemiological, clinical, radiological data, and hospital course) of possible factors affecting survival and outcome of pediatric traumatic brain injury patients were collected. Patient outcome was determined using the modified Rankin Scale at the time of hospital discharge and modified Glasgow Outcome Scale at 1and 3 months following discharge. Results At the time of hospital admission, 60% children had a Glasgow Coma Scale score of 3 to 8, and were admitted with severe head injury. At the time of discharge, 30% children had good functional outcome, with 50 and 58% children being functionally independent at 1 and 3 months following discharge, respectively. Deranged serum sodium level was an independent predictor of poor neurological outcome on multivariate analysis (coefficient: −3.90 [−5.14 to –2.66, p &lt; 0.001]). Conclusion Fifty-eight percent children, who were admitted to intensive care unit for mechanical ventilatory support, were functionally independent at the end of 3 months following discharge from the hospital, with modified Glasgow Outcome Scale score of 5 or “Normal.” Deranged electrolytes result in secondary brain injury, thus contributing to poor long-term outcome. Effective electrolyte management is essential to improve outcome after traumatic brain injury in children.

Effect of Coffee-Corn Mix on Hypertensive Mice on Biomarkers of Nitric Oxide, eNOS, Sodium, and ACE Serum Levels

Hypertension is a major determinant of morbidity and mortality worldwide. Hypertension is the most common cause of death in Southeast Asia. The pathophysiology of hypertension is complex and not fully understood. Increased oxidative stress is considered one of the main mechanisms involved in the pathogenesis of endothelial dysfunction leading to hypertension. Therefore, antioxidant therapy can be an alternative option to prevent endothelial damage and hypertension. Robusta coffee and corn are high sources of antioxidants. This study aimed to analyze the effect of the coffee-corn mixture on NO, eNOS, sodium, and ACE serum levels in hypertensive rats. This research is an experimental laboratory study with a post-test only control group design. Robusta coffee and yellow corn samples were roasted at 180°C for 10 minutes. Rats were induced by DOCA salt and given a mixture of coffee-corn in a ratio of 75%: 25% and 50%: 50% for two weeks. After treatment, the levels of NO, eNOS, ACE, and F2-isoprostane from blood serum were measured. The results showed that there was no significant difference in serum Nitric Oxide levels in the negative, positive control group and the treatment group after treatment. There was a significant increase in eNOS levels and a significant decrease in serum sodium, ACE, and F2-isoprostane levels in the negative, positive, and treatment groups. In the path analysis, it was found that the administration of the coffee-corn mixture (50%:50%) can reduce blood pressure through two pathways, namely a decrease in the level of F2-isoprostane, which causes a decrease in sodium levels and a direct decrease in sodium levels.

Early Postoperative Serum Sodium Level and Urine Output Volume Profile after Endoscopic Endonasal Transsphenoidal Surgery in Macroadenoma Pituitary Tumor

Introduction: Surgery is still the initial treatment of choice to for the majority of date with pituitary tumors. One of the most commonly performed minimally invasive neurosurgical procedures is transsphenoidal endoscopic endonasal surgery (ETS) and microscopic transsphenoidal surgery (MTS), used commonly for the resection of pituitary tumors. Neurosurgical operations for pituitary and suprasellar tumors may result in postoperative complications due to the crucial anatomical location of these tumors. The resulting postoperative complications can manifest as anterior or posterior pituitary dysfunction, particularly sodium disturbances, due to the changes in antidiuretic hormone (ADH) secretion, which remains one of the most frequent postoperative reasons for hospital readmission. Method: The aim of this study is to describe and determine the frequency distribution of patient characteristics who underwent endoscopic endonasal transsphenoidal resection of pituitary adenoma at Universitas Sumatera Utara Hospital between 2021 and 2022. Result: The findings of this study showed the frequency distribution of patient characteristics who underwent endoscopic endonasal transsphenoidal resection and postoperative sodium serum level profile as well as postoperative urine output profile. Discussion: The discussion section briefly discusses the findings and their implications. It mentions the high prevalence of headache and visual deficits among the patients, which aligns with previous studies. It also provides an overview of normal water balance and the pathophysiology of water balance disorders after pituitary surgery.

Effect of preoperative oral rehydration before cesarean section on ultrasound assessment of gastric volume and intraoperative hemodynamic changes: a randomized controlled trial

BackgroundCesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics.MethodsSixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was < 90 mmHg or decreased by > 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at < 60 beats/min heart rate. The primary outcome was the total number of vasopressor boluses administered. Secondary outcomes were the cross-sectional area of the stomach antrum, maternal plasma glucose levels, serum sodium levels, total intravenous fluid, bleeding volume, urine volume, operative time, and cord blood gas values after delivery.ResultsThe total number of vasopressor boluses was lower in Group O than in Group C (P < 0.05). Group O had lower total dose of phenylephrine than Group C (P < 0.05). There were no significant differences between Group M and other groups. No differences were detected regarding secondary outcomes.ConclusionsIn women scheduled for cesarean section, preoperative ORS stabilized perioperative circulatory dynamics. Neither ORS nor mineral water consumption increased the stomach content volume.Trial RegistrationThis trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019825: Date of registration 17/11/2015).

Mildly Low Serum Sodium Levels in Chronic Liver Disease: At Risk for Sarcopenia and Portal Hypertension.

Hyponatremia and sarcopenia in advanced chronic liver disease (ACLD) are both associated with portal hypertension (PHT) and worseprognosis. This study investigated their interrelationship. This retrospective study analyzed 751 patients with CLD who underwent magnetic resonance elastography (MRE) at Nippon Kokan Hospital (Kawasaki, Japan). Patients were classified and studied in five groups based on serum sodium (Na) levels: <135, 135-136, 137-138, 139-140, and >140 mEq/L. PHT was assessed by thrombocytopenia, varices, and ascites, and magnetic resonance imaging (MRI) data were used to diagnose sarcopenia. The proportions of the five groups were 3/4/13/32/48 (%), and the mean liver stiffness (LS) was 6.6/5.7/4.2/3.2/3.2 (kPa), with significant progressive increases at Na < 139 (p< 0.01). The incidence of all PHT events and sarcopenia also increased at <139 (each p < 0.01). By contrast, the LS thresholds for predicting thrombocytopenia, varices, and ascites increased from 3.5 to 4.7 and 5.1, respectively, and were the same at 3.4 for low Na (<139) and sarcopenia (all p < 0.01). Multivariate analysis of factors associated with low Na identified LS and sarcopenia as independent factors (p < 0.05 both). In the Cox proportional hazards model, low Na was a significant prognostic factor in ACLD (hazard ratio (HR) 5.33, p < 0.01); however, the albumin-bilirubin (ALBI) score (HR 2.49) and sarcopenia (HR 4.03) were extracted in the multivariate analysis(p < 0.05 both). Studies using MRE imaging showed that low Na levels in CLD are associated with worse prognosis, not only due to elevated LS (i.e., PHT)but also the strong association with sarcopenia.

Changes of Serum Electrolytes and Serum Vitamin C Levels in a Sample of Iraqi patients Infected with Helicobacter pylori (H. pylori)

Helicobacter pylori (H. pylori) is widespread and involved in the pathogenesis of the majority of stomach and duodenal diseases. Reduced stomach acidity facilitates the initial infection. Electrolytes (sodium, potassium, and chloride) are essential for the production of stomach acid. This study aimed to observe any changes in the levels of serum electrolytes (Na, K, and Cl) and serum vitamin C levels in a sample of Iraqi patients infected with H. Pylori. We studied 30 infected patients with H. Pylori and 30 matched healthy controls. The results revealed that the serum sodium, potassium, and chloride levels were significantly decreased (p = 0.002, 0.003 and 0.0001, respectively) in the patients infected with the H. Pylori group in comparison with those of the healthy controls. Also, vitamin C levels were significantly lower in patients infected with H. Pylori than in the control group (p = 0.001). The present results suggest that these changes may be attributed to or contribute to the infection itself through changes in gastric acidity, and this needs further study.

Predictors of Mortality among Ventilated Young Infants in Intensive Care Unit of a Tertiary Care Hospital

Introduction: The management of children with invasive ventilation in developing countries with limited resources is challenging. A large number of infants in intensive care unit require mechanical ventilation due to various conditions and have a high mortality. Aim of the study: To identify the predictors of mortality among ventilated young infant up to 2 months age in Intensive Care Unit of Bangladesh Shishu Hospital &amp; Institute. Methodology: The prospective observational study was conducted in the Department of Intensive Care Unit of Bangladesh Shishu Hospital &amp; Institute, from January 2020 to December 2020. Critically ill young infants upto 2 months age who required mechanical ventilation in Intensive Care Unit were included in this study. Data was collected on a structured proforma and included the basic demographic profile, presenting complaints, preliminary diagnosis, investigation results, mode of ventilation and initial ventilator parameters &amp; hospital stay and outcome. Permission from ethical review committee of the hospital was taken. Results: From 50 critically ill patients, mortality rate was 74.0%. Mean age was 14±10.1 days. Significant relation was found between the ventilated patients having FiO2, PIP, PEEP, HCO3, BE, serum sodium level, duration of ventilation and outcome respectively. Severe respiratory distress before death was found significantly related with outcome. Metabolic acidosis was found significant in death patients before ventilation and before death (75.7% &amp; 51.4%). Conclusion: The rate of mortality in the ICU was high. Initial high PIP, low HCO3, severe respiratory distress and prolong duration of ventilation (&gt;5days) were significant independent predictors of mortality.

A Conspectus of Euvolemic Hyponatremia, Its Various Etiologies, and Treatment Modalities: A Comprehensive Review of the Literature.

Hyponatremia is the most prevalent electrolyte imbalance encountered among hospitalized patients, athletes, the elderly, patients with chronic ailments, postoperative patients, and a few asymptomatic individuals. Clinical manifestations of hyponatremia can be diverse, with characteristic neurological symptoms. Depending on in-depth medical history, physical examination (including volume status assessment), laboratory investigation, and drug history, patients can be classified broadly as undergoing hypervolemic, euvolemic, or hypovolemic hyponatremia. However, patients with hypervolemic hyponatremia often present with distinctive signs such as edema or ascites, and the clinical presentation of hypovolemic and euvolemic hyponatremia poses significant challenges for clinicians. The convolution in clinical manifestations of patients is due to the varied etiologies of euvolemic hyponatremia, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), adrenocortical insufficiency, hypothyroidism, psychogenic polydipsia, different classes of drugs (chemotherapeutics, antipsychotics, antidepressants), endurance exercise events, and reset osmostat syndrome (ROS). The management of hyponatremia depends on the rate of hyponatremia onset, duration, severity of symptoms, levels of serum sodium, and underlying comorbidities. Over the last decade, the clinical understanding of hyponatremia has been scattered due to the introduction of innovative laboratory markers and new drugs. This article will be a conspectus of all the recent advancements in the field of diagnosis, investigations, management, and associations of hyponatremia, along with traditional clinical practices. Subsequently, a holistic overview has been laid out for the clinicians to better understand and identify knowledge deficiencies on this topic.

A Comparative Study of Serum Sodium and Potassium Levels across the Three Trimesters of Pregnancy

Aim: To evaluate the serum sodium and potassium levels in the three trimesters of pregnancy in women. Methods: Four groups of healthy women between the ages of 20 and 30 years, volunteered for this study. Group 1: Non-pregnant women (control), Group 2: Pregnant women in their first trimester, Group 3: Pregnant women in their second trimester, Group 4: Pregnant women in their third trimester. Blood samples were collected by standard aseptic method and serum samples were analyzed for serum levels of sodium and potassium by the ion selective electrode method. Results were presented as MEAN ± SEM in tables and figures, p &lt; 0.05 was regarded as statistically significant. Results: The serum sodium concentrations in mmol/L were 135.3 ± 3.09, 136.3 ± 1.55, 139.0 ± 0.78, 139.8 ± 0.91 for control, first-trimester, second-trimester, and third-trimester subjects respectively. The potassium concentrations in mmol/L were 3.678 ± 0.26, 3.687 ± 0.13, 3.820 ± 0.11, 3.767 ± 0.07 for control, first-trimester, second trimester and third-trimester subjects respectively. The Bodyweight values in kg were 72.13 ± 2.11, 74.73 ± 2.05, 75.00 ± 1.72, 81.56 ± 4.24 for control, first-trimest, second-trimester, and third-trimester subjects respectively. Conclusion: Results indicate that the hormones of pregnancy altered the body weight of pregnant women, but did not change the serum sodium and potassium level across the three trimesters of pregnancy in women. This is an indication that the kidneys of healthy pregnant women can handle serum electrolyte load during the period of pregnancy.

SODIUM AND CALCIUM LEVELS IN PATIENTS WITH CIRRHOSIS OF THE LIVER AND ITS CORRELATION WITH HEPATIC ENCEPHALOPATHY

Introduction: Patients with chronic liver disease have a specific susceptibility to an electrolyte imbalance that can deteriorate their condition to hepatic encephalopathy. It occursin about 57% of hospitalized patients with cirrhosis. Hyponatremia in cirrhosis is an in dependent risk factor for mortality and is common in patients with end-stage liver disease. These patients had a significantly higher incidence of hepatic encephalopathy, hepatorenal syndrome, and spontaneous bacterial peritonitis. Hepatic encephalopathy is worsened by the presence of hyponatremia and hypocalcemia. Aim:The aim of this study is to evaluate sodium and calcium levels in CLD patients and its correlation with hepatic encephalopathy. Methods: This cross-sectional study was conducted in SMHS Hospital,Govt.Medical College Srinagar, Jammu Kashmir,India, during a three-year period. 150 patients with chronic liver disease admitted to the general medicine and gastroenterology department were included. Data was entered in SPSS software version 20. Qualitative data were analyzed using chi-square, and quantitative data were analyzed using independent t-tests. A P-value &lt;0.05 was considered significant. Results: Our study on 150 CLD patients showed that the serum sodium level and serum calcium level were significantly lower in patients with hepatic encephalopathy with P-Values of 0.0006 and 0.002, respectively. Conclusion: It seems that reducing serum sodium and calcium level can be predictive of hepatic encephalopathy inpatients with chronic liver disease.

Predictors and dynamic online nomogram for postoperative delayed hyponatremia after endoscopic transsphenoidal surgery for pituitary adenomas: a single-center, retrospective, observational cohort study with external validation

BackgroundPostoperative delayed hyponatremia (PDH) is a major cause of readmission after endoscopic transsphenoidal surgery (eTSS) for pituitary adenomas (PAs). However, the risk factors associated with PDH have not been well established, and the development of a dynamic online nomogram for predicting PDH is yet to be realized. We aimed to investigate the predictive factors for PDH and construct a dynamic online nomogram to aid in its prediction.MethodsWe analyzed the data of 226 consecutive patients who underwent eTSS for PAs at the Department of Neurosurgery in Jinling Hospital between January 2018 and October 2020. An additional 97 external patients were included for external validation. PDH was defined as a serum sodium level below 137 mmol/L, occurring on the third postoperative day (POD) or later.ResultsHyponatremia on POD 1–2 (OR = 2.64, P = 0.033), prothrombin time (PT) (OR = 1.78, P = 0.008), and percentage of monocytes (OR = 1.22, P = 0.047) were identified as predictive factors for PDH via multivariable logistic regression analysis. Based on these predictors, a nomogram was constructed with great discrimination in internal validation (adjusted AUC: 0.613–0.688) and external validation (AUC: 0.594–0.617). Furthermore, the nomogram demonstrated good performance in calibration plot, Brier Score, and decision curve analysis. Subgroup analysis revealed robust predictive performance in patients with various clinical subtypes and mild to moderate PDH.ConclusionsPreoperative PT and the percentage of monocytes were, for the first time, identified as predictive factors for PDH. The dynamic nomogram proved to be a valuable tool for predicting PDH after eTSS for PAs and demonstrated good generalizability. Patients could benefit from early identification of PDH and optimized treatment decisions.

Admission hyponatraemia as heart failure events predictor in patients with acute heart failure.

Heart failure remained consistent as one of the biggest cardiovascular problems in Indonesia. Hyponatraemia is a common electrolyte disorder among patients presented with heart failure; however, the prognostic value for worsening heart failure has not been well defined. We studied 134 patients admitted with acute heart failure and investigated the relationship between admission serum sodium and the composite clinical outcomes of all-cause mortality and hospitalization ambispectively with a follow-up duration of 6months. We also try to look for low sodium-level impacts in several conditions. Among 134 patients, 84 patients presented with low sodium during admission, defined as a serum sodium level of <135mEq/L, and it was associated with higher composite clinical outcome risk [odds ratio (OR), 5.9; 95% confidence interval (CI), 2.8-12.0; P<0.001]. Moreover, hyponatraemia impacts on composite endpoints were driven by both parameters; it was independently associated with mortality (OR, 3.1; 95% CI, 1.4-6.8; P=0.003) and rehospitalization (OR, 5.3; 95% CI, 2.4-11.7; P<0.001). This result remained consistent in most subgroups. On-admission hyponatraemia is a predictor for 6month mortality and rehospitalization. Further work is needed to determine if correction of hyponatraemia translates into clinical benefit.

Risk of Hyponatremia after Tramadol/Acetaminophen Single-Pill Combination Therapy: A Real-World Study Based on the OMOP-CDM Database.

Tramadol has been reported to cause hyponatremia but the evidence is conflicting. The risk of hyponatremia resulting from combination oral tramadol/acetaminophen (TA) therapy is thus unknown. This study examined whether, compared with acetaminophen (AA), TA use is associated with an increased risk of hyponatremia. Hospital data compatible with the Observational Medical Outcomes Partnership-Common Data Model (OMOP-CDM; version 5.3) for 30,999 patients taking TA or AA from 2011 through 2020 were analyzed. New-onset hyponatremia was defined as a serum sodium level <135mEq/L within 10days after drug initiation. The incidence rate ratio was calculated based on crude and 1:1 propensity-score-matched models. Subgroup analyses compared patients taking TA extended-release (TA-ER) and TA immediate-release (TA-IR) formulations. Among the 30,999 patients, 12,122 (39.1%) were aged >65years and 16,654 (53.7%) were male. Hyponatremia within 10days developed in 1613 (8.4%) of the 19,149 patients in the TA group; the incidence rate was higher than in the AA group (4.2%; 493 out of 11,850 cases). In the propensity-score-matched model, the incidence rate of hyponatremia in the TA group was 6.8 per 1000 person-days (PD), which was 1.57-fold (1.31, 1.89) higher than that in the AA group (4.3 per 1000 PD). In both the crude and propensity-score-matched models, the incidence rate of hyponatremia was significantly higher in the TA-ER than TA-IR subgroup. In this real-world study, hyponatremia was more frequently observed in the TA than AA group, and in the TA-ER than TA-IR subgroup. Therefore, it is imperative to prescribe tramadol cautiously and closely monitor electrolyte levels.

Retrospective analysis of pulmonary cryptococcosis and extrapulmonary cryptococcosis in a chinese tertiary hospital

Cryptococcosis is an invasive fungal disease with increased morbidity in China over the past two decades. Cryptococci can infect immunocompromised hosts as well as immunocompetent ones. In this study, we reviewed data of 71 inpatients with cryptococcosis at Ningbo First Hospital from May 2010 to May 2020 and compared the clinical profiles of pulmonary cryptococcosis (PC) and extrapulmonary cryptococcosis (EPC). Of 71 patients (38 males, 33 females), 70 were non-HIV. The annual inpatient population increased dramatically, especially in the PC group. PC was confirmed in 77.46% (55/71) of cases by pathology. The rest were EPC including intracranial infection (15.49%, 11/71) and cryptococcemia (7.04%, 5/71). Compared with PC, a larger proportion of EPC patients were found to have immunocompromised conditions judged by predisposing factors (p < 0.01), or detectable humoral or cellular immunodeficiency. Fever and headache were more common in EPC patients (p < 0.001). Patients with EPC had lower serum sodium level (p = 0.041), lower monocyte counts (p = 0.025) and higher C-reactive protein (p = 0.012). In our study, the sensitivity of cryptococcus antigen detection for EPC was 100% regardless of sample type, while serum lateral flow assay (LFA) tested negative in 25% (5/20) of PC. Immunocompromised hosts are more likely to suffer from EPC than PC.

Incidence trends and risk factors for hyponatremia in epilepsy patients: A large-scale real-world data study

ObjectiveThis study aimed to evaluate the annual incidence and risk factors of hyponatremia in pediatric, adult, and older adult patients with epilepsy. MethodsWe enrolled 26,179 patients: 8598 pediatric patients (aged 0–15 years), 16,476 adults (aged 16–64 years), and 1105 older adults (aged ≥65 years). Patients were included if their serum sodium levels were measured between January 2006 and December 2020. Moderate-severe hyponatremia was defined as a serum sodium level of less than 130 mEq/L. ResultsFrom 2006 to 2020, 677 patients (2.6%) developed moderate-severe hyponatremia. The incidence of hyponatremia per 1000 person-years was 3.1 in the pediatric group, 19.8 in the adult group, and 50.4 in the older adult group. The incidence increased markedly from 36.8 in 2007 to 58.5 in 2020 in the older adult group but remained unchanged in the adult group and tended to decrease in the pediatric group. In the multiple logistic regression model, use of carbamazepine, valproate, phenytoin, phenobarbital, benzodiazepines, and antipsychotics was found to be a significant risk factor for hyponatremia. In adult patients, carbamazepine, benzodiazepine, and antipsychotics induced hyponatremia in a dose-dependent manner. Concomitant use of zonisamide reduced the risk of hyponatremia. SignificanceHyponatremia will become an increasingly important concern in clinical settings because the population of epilepsy patients is aging. Serum sodium levels should be monitored carefully when patients are receiving first-generation antiseizure medications or antipsychotics or combinations of these drugs. Our findings may help to minimize the risk of hyponatremia in epilepsy patients.

Effect of exercise on quality of life of patients with Chronic Kidney Disease

Background: Patients with chronic kidney disease (CKD) have less exercise capacity, and they are at higher risk of experiencing cognitive impairment, and lower health-related quality of life (QoL) than healthy individuals. Thus, the current study aims to assess the effect of exercise on patients’ cognition, QoL, and biochemical parameters. Methodology: This is an observational study to evaluate the effect of the exercise, which enrolled 90 patients with CKD (stage 3, 4, or 5) admitted to the Intensive Care Unit (ICU). Patients were made to do a 20-25 min exercise (breathing and limb exercises) and its effect on biochemical parameters (serum creatinine, sodium, potassium, and hemoglobin) was recorded from patient reports from day 1(T1; baseline) till day 7(T7). Further, the effect of exercise on cognition and QoL was assessed at T1 and T7 using the Mini-Mental State Exam (MMSE) and World Health Organization Quality of Life Instrument (WHOQOL-BREF), respectively. Results: Significant improvement in the level of serum creatinine, sodium, potassium, and hemoglobin were found in patients with CKD after 7 days of lower and upper limb and breathing exercises. Moreover, significant improvement in all four domains of WHOQOL-BREFi.e., physical health, psychological health, social relationship, and the environment was observed. Conclusion: This study showed that after 7 days of exercise, there was a significant improvement in cognition, biochemical parameters, and QoL in CKD patients.